Chapter 11: Symptom control and care towards the end of life
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Clinical governance
Nurses should be aware of the legal requirements for care of patients after death as it is essential that correct procedures are followed (Wilson [166]). It is particularly important that nurses are aware of deaths that require referral to the coroner (Box 11.7) as this will facilitate the correct personal care and enable nurses to prepare the family for both a potential delay in the processing of the Medical Certificate of Cause of Death (MCCD) and the possibility of a post‐mortem examination (Wilson [166]). If the death is going to be referred to the coroner, the patient's body should remain untouched. This includes leaving invasive lines and devices in situ. The patient must not be washed in case evidence is destroyed (Wilson [166]).
If the death was expected and there is no need for a referral to the coroner, local guidance should be sought as to the most appropriate person to proceed to remove lines and tubes from the patient. In some areas this will be the healthcare staff at the bedside during care after death; however, in some areas this is the responsibility of the mortician.
Guidance relating to vulnerable adults is available (Mental Capacity Act [93]). If after death safeguarding issues are raised, it is important to follow local policy and ensure that concerns are communicated with relevant agencies, such as Social Services, the police and the coroner.
Out‐of‐hours death
Where a death is expected to occur out of hours and for religious reasons the funeral will need to take place immediately after death, it is the responsibility of the medical team to ensure that the on‐call doctor is notified so that they can review the dying patient at the start of their shift and be able to complete the Medical Certificate of Confirmation of Death when death occurs. It is hoped that any cultural and religious guidance needed will have been ascertained with the patient and family through advance care planning in the event of an expected death (Wilson [166]).
In some exceptional cases, a family member or next of kin may be unable to wait over a weekend to meet with regular staff who would support the administrative process and guide the family. In these circumstances, the family or next of kin should be offered the following:
- Medical Certificate of Cause of Death (MCCD)
- any information the organization or trust has on what to do in the event of someone dying
- directions to the Register Office
- information on how to register a death
- hospital documentation to give to the undertakers formalizing release of the patient's body from the hospital
- information regarding bereavement support.
Infectious diseases
The Health and Safety Executive has issued guidelines on the handling of the deceased with infections; nurses, doctors and other healthcare professionals should be aware of related local infection‐control policies and reporting responsibilities (HSE [65]). It is vital that processes are in place to protect confidentiality, which continues after death, but this does not prevent the use of sensible rules to safeguard the health and safety of all those who care for the deceased.
Families and carers should also be supported in adhering to infection prevention and control procedures if they wish to assist in personal care after the death of an infectious patient. There are a few, very rare, exceptions when it is not possible for families to participate.
Porters, mortuary staff, undertakers and those involved with the care of patients who have died must also be informed if there is a possibility of infection. In all cases, local policies and guidelines should be followed.
